BOLL i^ssssSrSEST £-:" CODE jr of RULE'S AND REGULATIONS GOVERNMENT OF THOSE EMPLOYED IN THE CARE OF THE PATIENTS PENNSYLVANIA HOSPITAL FOR THE INSANE, NEAR PHILADELPHIA.. SECOND EDITION. PREPARED AND PRINTED BY AUTHOEITY OP THE BOARD OF MANAGERS PHILilV^iVPTIIA: T. K. AND P. G. COLLINS. PRINT Kite. 1850. I \ V CONTENTS. PAGE Introductory Remarks, ...... 5 11 13 Duties of supervisors,....... 15 of teachers, . . . . \ . 16 of attendants,....... 17 1. Intercourse with patientsr 17 2. Supervision of patients and wards, 19 3. Morning duties, . 20 4. Cleanliness and ventilation of wards, 20 5. Meals and giving food, .... 21 6. Administration of medicine, . 23 7. Bathing, ....... 24 8. Shaving,....... 24 9. Walking out with patients, 25 10. Patients at work and out-door attendants, 27 11. Reading in wards, and lecture-room enter- tainments, ...... 27 12. Retiring at night,..... 28 13. Seclusion of patients in their rooms, 30 14. Restraining apparatus, 30 15. Escapes, ... . 31 16. Suicidal cases, 32 17. Dangerous weapons, . . . . 33 18. Prohibited articles, . . . . 33 19. Patients' clothing,..... 34 20. Visiting between wards, . 35 CONTENTS. 21. Leave of absence, . •.*.' 22. Notice to leave and discharges, Duties of special attendants, , . of watchman and watchwoman, of seamstress, of coachman, of carpenter, of gardener, of gatekeeper, Admission.of visitors, Conclusion, INTRODUCTORY REMARKS. The history of the institution for which this code of rules and regulations has been prepared extends back to the ye'ar 1752, when a number of the benevolent citizens of Philadelphia established in that city the Pennsylvania Hospital, which, besides its admirable provision for the indigent sick, is distinguished as being the first establish- ment for the care and treatment of the insane, in Ame- rica. From the foundation of the institution till the first day of 1841, the insane were received and treated in one wing of the hospital in the city; but its position in the midst of a flourishing metropolis, its contracted buildings, its limited extent of ground, its want of privacy, and, above all, its having no distinct medical organization for the in- sane department, rendered it obvious that a different arrangement, with a country location, would have many important advantages. Fortunately, the wise foresight of the early managers of the hospital had secured a number of vacant lots around their original structure, and the sale of these, in 1836 and 1837, produced a fund from which a farm was purchased, and the buildings now known as " The Penn- 2 6 INTRODUCTORY REMARKS. sylvania HosriTAL for the Insane," were erected, and furnished for the accommodation of patients. The Pennsylvania Hospital, in both its branches, is strictly a benevolent institution. Founded by the libe- rality of private citizens, its main dependence has always been upon the contributions of the charitable, and all its funds are sacredly devoted to the relief of the afflicted, and spreading its advantages among those who could not otherwise partake of them. Every increase of its re- sources enables it to extend its sphere of usefulness in the community. Every one, therefore, who engages in any post connect- ed with this institution should feel that he is bound in honor to fulfil a part of this great trust, and by a faithful performance of duty, to aid as far as possible in carrying out the great objects of its benevolent founders, to make it truly a blessing to every afflicted one that enters its doors, a spot where only kindness and genuine sympathy reign, and where all that is possible is done to mitigate the sufferings of our fellow-beings. The Pennsylvania Hospital for the Insane was opened for the reception of patients on the first day of 1841, since which 1753 have been received, and 821 have left us, restored to perfect health; while a large number have returned home, with various degrees of improvement. The institution has been steadily acquiring a firm hold on the confidence of the friends of the afflicted, and of the community, and every one connected with it is ex- pected so to act in all things as to prove that this confi- dence is not misplaced, but that even a higher degree of it will yet be deserved. The treatment of the insane was formerly but little un- derstood, and it is to be feared that many abuses and cruel- introductory remarks. 7 ties of a revolting nature were practiced upon patients by their ignorant and unfeeling attendants, to the lasting in- jury of the sick, and the eternal disgrace of those guilty of participating in them. Although the prevalent views of that period may have offered some excuse for such proceedings, no such reason can be tolerated for a moment now, when it is as clearly demonstrated as is the existence of the sun on a bright noonday, that insanity, in all its forms, various as they are, is a disease, the subjects of which are never to be exposed to a rude remark or a rough act, but who are always to be treated with courtesy, respectful kindness, and sympathy—who are to be aided on all occasions in finding means with which to interest, amuse, or employ themselves, and who are ever to have excuses made for the wayward, irritable, violent, or careless acts which spring from a disease over which they have no eontrol, and which destroys responsibility for their actions. These are the only views of this disease that can be held by those about the insane that will allow full jus- tice to be done to the patient. Every one must remem- ber that the engagement to perform duties in an institu- tion for the insane implies an obligation on his part, religiously, and to the best of his abilities, to carry out all rules, prepared by the proper authority, in their true spirit, and to submit without a murmur to such acts of patients as spring from their disease. By a uniform course of steady, unwavering attention, gentleness, kind- ness, and sympathy towards every one under their care, all employed will certainly command the confidence of those directing the institution, will win the gratitude of the afflicted, and, above all, secure the approbation of their own consciences. introductory remarks. Insanity is no respecter of persons; no one can claim an entire exemption from it; and none of us know how soon we, ourselves, or some of our dearest friends, may require the very attentions we are now giving to stran- gers. Let us ask ourselves, when almost worried out with our charge—when on the point of forgetting that we have to do with those who are not responsible for their actions —what kind of treatment we would wish for ourselves or our relatives, when similarly afflicted, what steady kind- ness, what persevering attention, what delicate sympathy under all circumstances—and we shall know what is due to others. Never let us forget that motto, which, above all others, is appropriate in every institution for the in- sane—" all things whatsoever ye would that men SHOULD DO TO YOU, DO YE EVEN SO TO THEM." Come what may, the law of kindness must be the go- verning one in this institution, and all other qualifications will pass as nothing, if the disposition to carry out this law is absent. Those who do not at heart adopt this sen- timent are unfit to take charge of the insane, and those who violate this principle are not wanted here; they are unfaithful to their trust, and can never do themselves credit in taking care of such patients, nor aid in promot- ing the prosperity of this institution. It will almost invariably be found that, where we can- not succeed in our object by mild measures, force will fail, and disputes, violence, and recriminations are always pro- ductive of injurious effects. To perform properly the duties of any station connected with the insane, requires high moral feelings, great self-denial, and a severe school- ing of the temper and disposition. If this is thoroughly done, every one is enabled to become highly useful in one of the most exalted fields of benevolence. Simply to perform special duties is not all that we require; we wish INTRODUCTORY REMARKS. 9 to see .an active interest felt in all the patients—a desire to add to their comfort in every way, and to advance their cure—steady efforts to interest or amuse them—a watch- ful care over their conduct and conversation, and a con- stant sympathizing intercourse, calculated to win their attachment, and command their respect and confidence. All situations about the insane are well known to be arduous and responsible, but a faithful performance of duty in any one of them cannot fail to give a kind of character that must prove useful in other walks of life; and it is sincerely hoped that many who may be employed hereafter in this institution, like not a few who have left us, will in after years look back with satisfaction, not only upon the good they have been instrumental in conferring upon their suffering fellow-beings, but upon the direct benefits they have themselves derived from a residence in the institution. While we are employed here, we must never allow our- selves for a moment to forget that this noble institution was prepared for the benefit and happiness of its patients, and not for our convenience or advantage, and that to pro- mote the former, we must all expect to submit to many little annoyances, inconveniences, and privations. The Board of Managers having intrusted to the under- signed the general superintendence and direction of every part of this establishment, he looks forward with confi- dence from all, for that cheerful obedience to rules, and that zealous and prompt performance of duties at all times, which will add greatly and certainly to the happiness of the patients, and to the reputation and usefulness of the institution. THOMAS S. KIRKBRIDE, Physician to the Hospital. 2* OFFICERS. By the by-laws of the Pennsylvania Hospital for the Insane, the resident officers of the institution consist of the Physician, Assistant .Physician, Steward, and Matron. By these by-laws, the physician is made the official head of the institution, having a general superintendence and control of it, and of all persons employed on the pre- mises; and among his duties is prescribed that of making, with the sanction of the attending managers, such regu- lations for the government of all engaged in any way about the patients, as he may deem proper. The first edition of these rules was prepared before the opening of the hospital, in 1841, and the present code is only modified and extended in such respects as experience has shown to be desirable, to secure more fully the grand objects of the institution. In the performance of their respective duties, all the officers feel bound to know, by frequent personal inspec- tion, that every department of the institution is properly carried on—that all persons are faithful to their trusts— and that the patients are in every way properly treated and attended to. * To do this, they must necessarily make frequent visits to every part of the house, and each one OFFICERS. 11 engaged in any department will be careful to receive these visits kindly and respectfully, and on all occasions to attend to the suggestions that may be made in a prompt and cheerful manner, as the other officers are expected at all times to report to the physician, without reserve, the results of their observations. When the physician is absent, he is represented by the assistant physician, who will be applied to in reference to the patients and attendants. GENERAL RULES. In making engagements with individuals to take charge of the patients of this institution, it is to be distinctly un- derstood that the hospital contracts for their whole time, and that they are not to leave the premises or their duties, nor engage in work of their own, without express permis- sion from the physician. They are expected to perform with cheerfulness, and to the best of their abilities, all duties that may be assigned them by the officers of the house, and at all times and in all places to do what they can to promote the comfort and happiness of the patients, and the prosperity of the insti- tution. They are to treat the patients, every one having busi- ness at the institution, and each other, with respect and courtesy. They are to be neat in their dress, avoid wear- ing their hats in the house, going in their shirt sleeves (unless when specially at work in the wards), lounging on settees, the use of profane language, all vulgar habits, and every kind of act unbecoming their position. Like the officers and patients, they are expected to forego the use of tobacco and intoxicating drinks of every kind while in the employ of the hospital. GENERAL RULES. 13 When the officers or visitors are present in the wards, they will rise, and be prepared to give such information as may be required of them. When abroad, they are to avoid reporting the conduct, conversation, or names of patients, and are never to speak disrespectfully of the institution or any of its officers. No one belonging to the North Wing, nor any male employed on the premises, is to enter the South Wing on any pretence, or go upon the grounds appropriated to the female patients, without express leave. It is so highly important that patients should, as far as possible, be kept constantly at some pleasant kind of employment—either work of some kind, or riding, walk- ing, or amusements—that no suitable opportunity is ever to be neglected to induce the patients thus to occupy themselves. While cheerfulness is always desirable in the wards, marked levity of conduct is unbecoming and undesirable among the insane, and all should be careful to make this important distinction. It is very desirable that patients should leave the insti- tution with pleasant recollections of their stay in it, and every one coming in contact with them can do much to promote this end. Although the testimony of an insane person, of course, is often not to be depended on, and while a few even after recovery seem to labor under some delusion as to what happened during their sickness, still it is undeniable that, in most cases, patients who have recovered are quite competent to give a correct account of what occurred during their sickness, of the treatment they received from those about them, and much other information highly important to those managing hospitals. It is hoped that in all cases this testimony will be such 14 GENERAL RULES. as to increase the standing and respect due to those having the immediate care of the patients in this institution. When absent, the hour for return in the evening is half past nine. At a quarter before ten, the gate will be locked, and no person admitted afterwards without being reported to the proper officer. As this code of rules has been made to promote the welfare of the hospital and its inmates, and the comfort of every one connected with it, it is hoped that violations of them will rarely occur, and that all will feel bound to do what they can to secure obedience to them, and never take offence when their defects are pointed out or im- provements suggested. DUTIES OF THE SUPERVISORS. 15 DUTIES OF THE SUPERVISORS. The supervisors of the respective wings are bound to see that the rules contained in this code are faithfully carried out in every particular; that the attendants per- form their duties properly; and that all the patients are made as comfortable at all times as circumstances will permit. They will very frequently pass through the different wards, especially those containing excited patients, and occasionally through the pleasure grounds, and will aid and encourage the attendants in their efforts to interest, amuse, and employ the patients in every way in their power. They will especially attend to the prevention of dis- turbances among the patients, to the preservation of order and quiet in the house, and in all things assist in carrying out the general views and instructions of the physician in reference to the treatment of the patients. They will promptly report all irregularities or improper conduct or unfaithfulness in the performance of duties that come under their notice, will give advice to the attendants, and point out any neglect that they may dis- cover in any of the wards. They will keep a daily journal of their observations, which they will place in the office each morning for in- spection by the physician previous to his regular visit. 16 DUTIES OF THE TEACHERS. DUTIES OF THE TEACHERS. The teachers are expected to make themselves com- panions to the patients, and in the performance of their duties to aid in the supervision of the wards. They will pass through the different wards frequently in each day, will advise the patients in the selection of books, encourage them to engage in the different kinds of employment, suggest means of amusement, and by their conversation and example do all in their power to promote their happiness, and aid in carrying out the wishes of the physician. As may be directed by the physician, they will impart instruction to certain patients, read and superintend amusements, in the different wards at stated hours, and take such part in the entertainments in the lecture-room as may be deemed desirable. They will, while in the different wards, carefully ob- serve the general treatment of the patients, and they are to suggest to the attendants whatever they think will add to the comfort of the patients or the tranquillity of the wards, and will report any neglect or improper conduct that may come under their notice. They will keep a journal of their observations, which they will place in the office, each morning, for inspection by the physician previous to his regular visit. DUTIES OF ATTENDANTS. 17 DUTIES OF ATTENDANTS. 1. Intercourse with Patients.—In all their inter- course with the patients, the attendants are to treat them with respect and civility, are to address them in a mild and gentle tone of voice, and avoid violence and rudeness of every kind. All civil questions are to be properly answered. All reasonable requests are to be promptly attended to. They are to keep cool under every provo- cation ; are never to scold, threaten, or dictate authorita- tively; but, whenever they desire anything done by a patient, are to make a request in a respectful manner. Force, unfortunately, has sometimes to be used in every institution for the insane; but tact and kindness render its employment comparatively rare, and whenever it must be resorted to, the manner of using it may be made to take away nearly all its offensiveness. A pleasant smile, a cheerful, kind, and respectful manner, and sympathizing words, will go far to convince even the most excited pa- tient that what is done is from good motives, and that he has little to fear from those around him. The opposition of patients, and much of their violence, very often arise from delusions that lead them to suppose that they are to be injured in some way; and every at- tempt either to put them in a. room, to give food, baths, or medicine, or to do anything about their persons, if 3 18 duties of attendants. made with angry looks, cross words, or violence, only tends to confirm their false ideas and make their resist- ance the more obstinate and determined. The truth of these views is unquestionable, and is con- firmed daily by convalescent patients, who are able to describe their motives and feelings when highly excited. Under no circumstances will an attendant be excused for striking a blow, or laying violent hands upon a patient, unless in the clearest case of self-defence, or to prevent his committing serious injury to himself or others. Attendants are never to manifest fear of any patient, but, while treating them with firmness and decision, at the same time it must be with mildness and kindness. They must take every proper opportunity to inspire the patients with respect for and confidence in the officers, and to convince them of the true character of the institution, and of its leading object, the promotion of the restoration and comfort of its patients. They are promptly to interfere when patients are dis- posed to quarrel, and by kind words, and engaging their attention with other objects, prevent difficulty. A kind word fitly spoken will prevent many a scene of excitement, just as a harsh remark, an angry look, an unkind allusion, or a rude act, on the part of an attendant, may be the origin of difficulties which will last for hours. They are to carefully avoid talking to patients on the subject of their delusions, or to others in the hearing of the patients, and, as much as lies in their power, they should endeavor to prevent others from doing so. They must never allow patients to be laughed at, ridi- culed, or harshly spoken to on account of their delusions or the peculiarities of their behavior. No greater proof duties of attendants. 19 of a want of correct feeling could be given than indulging in levity in reference to the afflictions of our fellow-beings. Deception is always to be avoided, and particular care is to be taken that promises are not made that cannot be performed. They are not to furnish writing materials or books to the patients, nor make purchases for them, without con- sulting the physicians. All letters, parcels, or packages (except clothing) to or from patients are to pass through the hands of the physi- cian. When patients have tobacco, or forbidden articles of any kind, it is the duty of the attendant promptly to report it. All damage done by patients is to be entered on a book provided for the purpose, and through the supervisor de- livered to the steward at the end of every week. 2. Supervision of Patients and Wards.—Each attendant is responsible for every patient under his or her care, and is expected to be able at any moment to say where each individual can be found. If any one is discovered to be missing, report is to be immediately made to the supervisor and one of the officers, and the proper search instantly instituted. An attendant allowing a patient to go out of a ward is considered responsible for his or her safe return. One attendant must always be present with the patients in each ward, unless express directions are given to the contrary. When it is necessary to leave, except for a very temporary purpose, it must be known that a substi- tute fills the place. When patients remain much in their own rooms, the attendants are to find reasons for frequently calling to see 20 DUTIES OF ATTENDANTS. how they are engaged, or if tlioy require any particular attention. On certain occasions, one attendant may guard two contiguous wards for a very short period—but not other- wise, unless by special direction of one of the physicians. 3. Morning Duties.—The attendants will rise punc- tually at the ringing of the bell, and take charge of their wards before the night watch goes off duty. They will then open the chamber doors, give the patients a kind greeting, at least wish them "good morning," and see that they are properly dressed, well washed, and have their hair and clothes neatly brushed. Immediately after opening the doors, the attendants will remove the chamber utensils, never without being covered, from the rooms, and have the bedding laid on chairs for airing. They will then commence putting the rooms and corridors in good order, and, after the beds and bedding have been sufficiently aired, have them properly made up for the day. Every part of the wings is to be prepared for inspection at the physician's visit, which will be commenced not later than eight o'clock every morning. 4. Cleanliness and Ventilation of the Wards.— Every part of the wards is to be kept scrupulously neat, clean, and well ventilated at all times. Whenever any unpleasant effluvium is discovered, the cause of it is to be searched for and promptly removed, day or night. When any part of a parlor, chamber, or hall is acci- dentally soiled, it is to be cleaned at once. duties of attendants. 21 Whenever a bed or the furniture of a room has been disarranged, it is to be promptly put in order. The halls and parlors must be swept as often in each day as is necessary to keep them perfectly clean. If an attendant from one ward, in passing through an- other, spills oil, medicine, &c, he is bound at once to clean the place. Unless directions are given to the contrary, the cham- bers and corridors are to be scrubbed at least once a week, and as much oftener as may be required. The spittoons are to be kept clean, and frequently emptied. The water closets, urinals, &c, are to be care- fully watched, and prevented from impairing the purity of the air in the ward. Nothing is clean enough if it can be made cleaner. All beds that are soiled are to be removed from the wards immediately after the patients rise in the morning —and after breakfast clean ones are to be substituted. If only wet, the wet straw or hair is to be removed, and boiling water poured through the soiled part, after which it is to be thoroughly dried before being returned to the chamber. A clean sheet and pillow case are to be put on each bed at least once a week, and when the spreads become soiled they are to be sent to the wash-house. When patients wish to lie down during the day, they are to go to their own rooms for the purpose—and the attendants will see that the bedding is not soiled, and that it is put in order as soon as they get up. The health of many patients requires this indulgence every day. 5. Meals and giving Food.—The attendants will see that the patients arc always up and ready for 3* 22 duties of attendants. breakfast, at the prescribed hour. They will carefully observe that they pass to and from the table in good order, returning directly to the wards when they leave the dining-rooms. When patients take their meals with the officers in the centre building, they are to be accompanied thereto, un- less they have the full privilege of the grounds. Those patients who take their meals in their own rooms, or at a table in the ward, are to be served promptly, and especial care is to be taken that their food is brought to them warm, and in good order, and, whenever necessary, an attendant is to remain with them while they are eat- ing. Care is to be taken that no knife, fork, or other article, that could*be used as a weapon, is left in the ward, or taken from the tables. When any such instrument is missed, prompt measures must be taken for its recovery. The attendants will not leave their wards for the pa- tients' meals, nor for their own, till the ringing of the bell to call them for these purposes. They will return promptly to their wards after finishing their own meals. The steward and matron will visit, as often as possible, all the dining-rooms, during the hours for meals, and also have a supervision of the mode in which patients have their meals served to, them in the wards, or in their rooms. All deficiencies or wants are to be promptly re- ported to these officers, and their instructions on these points are to be strictly attended to. Patients are never to be forced to take food but in the presence of one of the physicians, the steward or matron, the supervisor or teacher—and never but by the express direction of one of the physicians. duties of attendants. 23 G. Administration of Medicine.—The trays con- taining the medicine cups will be called for at the office by the supervisor, or such person as may be indicated by the physician, half an hour before breakfast and dinner, and at 7 P. M. The attendants will receive their trays as they are carried through their respective wards, admin- ister the medicine, see that it is all properly taken, wash the cups, and have the trays ready to be sent back by the individual who calls for them when returning to the office. If there has been any difficulty in taking the medicine, the attendants will report the fact to the person carrying the trays, who will make a verbal report to the assistant physician, or a register of it on a book which he will leave at the office on his return. The utmost gentleness is to be used in giving medicine, and every proper means employed to induce the patient to take it willingly. When it is positively refused, and the physician believes its administration important, either the assistant physician, steward or matron, supervisor or teacher, must be present, before any force can be used. When the attendants suppose any mistake has occur- red in the medicine sent, or when a patient complains of being sick, or having any unusual symptoms, the medi- cine should be retained in the cup till one of the physi- cians can be seen upon the subject. Any striking or unexpected effect in the operation of medicine is to be promptly reported. When a patient complains of being sick, or is supposed to be so, the fact should be reported without delay to one of the physicians. The person carrying the medicine from the office can- not select a substitute, on any occasion, without the con- sent of one of the physicians. 24 DUTIES OF ATTENDANTS. 7. Bathing.—Unless a special exemption is made by the physician, every patient will take a warm bath once a week. The temperature to be such as is most grateful to the patient. Unless otherwise specially directed, hot baths, adminis- tered for medical purposes, will be given at a temperature of 98°, as shown by the thermometer, and this tempera- ture is to be kept up by the addition of hot water as may be required. While in these baths, the patients are to have a towel frequently wrung out of cold water, kept constantly on the head. Where it can conveniently be arranged, immediately before retiring to bed is the best hour for giving this kind of bath. When not otherwise directed, and the patients exhibit no weakness, they should remain in the bath thirty minutes. If the patient ap- pears weak, or complains of any unusual symptoms, he should be taken out of the bath, and promptly placed in bed. When these baths are ready for use, the supervisor or teacher should be informed, that they may be present. Mustard foot baths should be used at as high a tempera- ture as the patient can comfortably bear, and the addition of hot water will occasionally be required to keep up the temperature. From one to two tablespoonfuls of mustard should be put in each bucket of water. The feet should be kept in the water not less than twenty-five minutes. These baths should be taken immediately before going to bed. On lecture nights they are to be given after return- ing from lecture. No one able to attend a lecture should ever be kept from it to take a bath, which should be given afterwards. 8. Shaving.—The shaving of patients is to be done by the attendants in each ward at stated intervals, and DUTIES OF ATTENDANTS. 25 patients who desire to be shaved more frequently are to be gratified in this particular. Great care is to be taken that no injury is done with the razors, all of which are to be carefully kept by the attendants. When the phy- sician has allowed a patient to shave himself, an attendant must always be present, and no other patient in the room at the time. 9. Walking out with Patients.—It is desirable that every patient not too feeble, or too sick, should walk out about the grounds at least once in each morning, and once in each afternoon. Immediately after the physician's morning visit, in suitable weather, one attendant in each ward should pre- pare to go out with as many patients as it is proper to take at once—the other attendant remaining to do the work of the ward. Upon the return of the first company, a second should go out, and so on till all in the ward have had the proper amount of exercise. In the after- noon, the same plan should be adopted and continued till near tea time. When walking out with patients, the attendants will as far as possible consult their wishes, in regard to the direction of the walk, &c.—will be vigilant to keep them together and prevent their strolling—take care that those from different wards mix as little as possible, and that no more are taken in one company than can be properly attended to. When patients' habits are careless, the attendants will see that they do not lie on the ground, or improperly expose themselves to the sun, &c. Attendants, when out with patients, will avoid entering into conversation with each other, reading, &c, by which their proper supervision may be prevented. 26 DUTIES OF ATTENDANTS. No patient can remain out after tea in summer, nor after sunset in winter, without special permission from the physician. All patients going out to walk beyond the yards must be accompanied by an attendant, unless the physician has given them the privilege of the grounds. Those having this privilege are expected always to be punctual at meals and in returning to the ward—are to avoid entering the centre building or basement story, or remaining standing about the gateway, or on the pathway leading from it to the centre. If any patient, having the privilege of the grounds, or absent by special permission, does not return at the ap- pointed hour, the attendant in charge will report the fact to any of the officers, and ascertain the reason therefor. Patients are not to be taken upon the dome without special permission. Patients are not to walk outside of the enclosure either with or without attendants on the Sabbath, except to attend a place of worship. Only those patients who conduct with entire propriety are to walk in the centre yard, and after 8£ P. M. all employed are to avoid walking there. New patients are not to be taken outside of the en- closure till the physician has signified his approbation of their having this privilege. When attendants wish to take a company outside of the enclosure, they will first report to one of the physi- cians, or to the supervisor, whom they propose taking, where they are going, and how long they expect to be absent. When outside with patients, attendants will be espe- cially careful to avoid crowds, railroads, and all other DUTIES OF ATTENDANTS. 27 dangerous places. They will strictly avoid paying any visits when they have patients with them, or entering any tavern or house for any purpose. The physician alone gives the privilege of the grounds, or permission to patients to pay visits at home or else- where. 10. Patients at Work and Out-door Attendants. —Such patients as are deemed suitable will be allowed by the physician to go out to work, under the care of the out-door attendants, gardener or farmer; but no one is to be taken out of the wards for this purpose, unless some general permission of the kind has been previously given by this officer. The attendants will take especial care that the patients do not engage in improper kinds of labor, and that they do not overwork themselves. These patients must always be kept under observation, and when a strong disposition to escape is manifested, they must be constantly near the attendant. No patient should be taken out of a ward to work, or for other purposes, by an officer or by any other person, without mentioning the fact to one of the attendants. All attendants are expected to go out and work with patients, whenever it is deemed desirable for them to do so; and when thus engaged, they will carefully avoid every appearance of superintending the patients, instead of working with them, but should induce them to labor by persuasion and example, and not by giving orders to them. 11. Reading in the Wards and Lecture-room Entertainments.—Immediately after tea, on the eve- ning of every Sabbath, the patients of the different wards, 28 duties of attendants. who are sufficiently calm, will assemble in the two large rooms in the centre building to listen to the reading of the Holy Scriptures. One attendant from each ward will invariably attend with the patients under his or her care, and who should be properly solicited to bo present. When, from any cause, an attendant cannot be spared from a ward, the supervisor will arrange who shall re- main in care of the patients. At 5 P. M. of each Sabbath, the teacher of each wing will read portions of the Bible to the patients of the 6th and 7th wards, at which reading one attendant must always be present. On certain evenings of each week, the teachers will read to the patients of the 3d and 4th wards, in the parlor of the 3d ward. The attendants will take pains to have all attend who are suitable, and one attendant from each of these wards will always be present. The same course is to be observed in the reading to the patients of the 6th and 7th wards. On the evenings of entertainments or lectures in the lecture-room, one attendant must be present from each ward from which patients attend, the other attendant remaining in the ward to take charge of it during that period, unless, under certain circumstances, one attendant is left to take charge of two adjoining wards. But all attendants not employed in taking charge of the wards are expected to be present with the patients in the lecture- room. 12. Retiring at Night.—Patients are not to retire before 8 P. M. without permission, unless in cases of sickness or fatigue. After the bell rings at 8£ P. M., patients may retire in every part of the house. Those in duties of attendants. 29 the first and second wards may remain up afterwards, according to their wishes, so that they retire in time to allow tho attendants to close their doors at half-past nine. Attendants, as well as patients, are expected to be in their rooms at a quarter before ten o'clock, and after ten o'clock no light can be kept burning in any room, unless in case of sickness. In each ward, however, one light will be kept burning in the hall, to be used in cases of emergencies. After patients have commenced retiring, all persons are to be careful to avoid making a noise of any kind that might disturb those who are in bed. In the 3d, 4th, 6th, 7th, and 8th wards, the clothing of patients, unless when otherwise directed, is to be kept outside of the rooms, always neatly folded and placed on a chair or settee near the door, and is to be handed in to the patient when the door is opened in the morning. Where patients lodge in a different ward from that in which they pass the day, it is the duty of the attendant having them in charge during the day to take them to their rooms and see them comfortably in bed, unless other- wise directed; and it will also be the duty of the attendant of the ward in which they sleep to see them up and dressed in the morning, and returned in seasonable time to the ward from which they came the previous evening. Before closing the door, the attendant should wish the patient a good night, and be certain that he is actually in the room. The door is then to be locked and tried, to ascertain that the bolt has properly slipped. No patient's door is ever to be left unlocked at night, without special permission from the physician being given to the attendants of the ward and to the night watch. 4 30 duties of attendants. 13. Seclusion of Patients in their Rooms.— Whenever a patient becomes so noisy or so violent that the attendant, after trying all proper means, believes it necessary to place him in a private room, he should pro- vide such assistance as will convince the patient that resistance will be useless. It must then be done in the most mild and gentle manner possible. When the pa- tient is in the room, the attendants should sit down quietly by him, and calmly tell him why he has been placed there, and that he will be released as soon as he is able to control himself. No matter how unreasonable the patient appears, this should always be done. Under no circumstances can it be justifiable to force a patient into a room, and suddenly close the door, without a word of explanation. A room having a wire or close shutter, and if possible a wicket door, is always to be selected for the seclusion of an excited patient. As soon as the patient is in the room, the fact is to be stated to one of the physicians, or a memorandum of it left on the office slate. Where it is necessary that patients should be secluded in their own rooms, the attendants should be careful to see to them frequently, to ascertain that they have every- thing proper that can minister to their comfort, and to know in what manner they are occupied. When a patient is very violent, one person on each side taking an arm, and a third at his back, can almost always convey any ordinary individual to his room, or re- move him from ward to ward, with but little difficulty or injury to any one. 14. Restraining Apparatus.—The use of restrain- ing apparatus is productive of so many and such serious duties of attendants. 31 evils, and is now so nearly abolished in all well-conducted institutions for the insane, that it will not be permitted to be applied here in any case, except by the express direction of the physician of the institution, or, in case of his absence from the premises, by that of the assistant physician. Seclusion to a private room, and the personal care of attendants, must be relied on till the physician can be found, and his directions in reference to future proceed- ings given. It is, in most cases, much better for one or two attendants to sit by a patient for several hours than to put on any restraining apparatus, although the latter may in very rare cases ultimately be necessary, and even beneficial. Whenever patients are fastened on the bed by the ap- paratus used for that purpose, or when their hands are confined in any way, the attendants must never forget that, thus situated, they require constant attention, as they are unable to assist themselves, and may thus easily get into habits that will afterwards give great trouble and annoyance. 15. Escapes.—The escape of patients is always ex- ceedingly annoying, and, although such events will occa- sionally occur, it must never be allowed to be from neglect. Patients are more apt to escape when passing from one part of the building to another, or when allowed to pass out for some particular purpose—or if near a crowd, or in the streets of a city—or about twilight. At such times and in such places, therefore, they must be particularly watched. An attendant's eye should always be kept on a patient known to be disposed to escape. 32 duties of attendants. When it is clearly made out that a patient has escaped from the carelessness or neglect of an attendant, the ex- pense of recovering the patient will be charged to the attendant, at the discretion of the physician. When a patient is found to be missing, a search should at once be instituted where the individual was last seen, and if any traces are discovered, pursuit should be in- stantly made. But, if not discovered at once, the fact should be promptly communicated to one of the physi- cians, or other officers or supervisors, and any other at- tendant that may be met with. The officers will then give directions what course is to be adopted to recover the patient. The attendant following the patient should, if possible, leave word in what direction he proposes going, and should know that some one takes special care of the patients he leaves. When a patient is brought back, no offensive allusion is to be made to the escape; but he is to be treated in all respects as if nothing of the kind had occurred, except that he is to be watched more carefully in future. 16. Suicidal Cases.—When patients have a disposi- tion to commit injury on their own persons, all experience goes to show that there is no certain security but by con- stant watching. Care should be taken to place out of reach all the means that would be likely to be resorted to, and the patient must be kept constantly in sight, treated with great kindness and sympathy, and his atten- tion drawn as much as possible from the subject. It must never be forgotten that, in a bad case, a single minute of neglect may be as serious in its effects as a whole hour. Before placing such a patient in his room, it should be duties of attendants. 33 carefully inspected; and when the clothing is taken off, it should be examined or removed entirely from the chamber. Especial care is to be taken of such patients about twi- light, or while others are going to or passing from meals, or to or from lectures, and at all times when the general attention is likely to be distracted, as these are the hours when attempts are most likely to be made. In case an attendant should ever discover that such an accident has occurred, he must maintain his coolness, give prompt relief if any can be rendered, then lock the door, quietly inform one of the physicians or other officers, the supervisor, teacher, or another attendant—but give no alarm that would excite other patients, or do anything that would lead them to discover what has occurred. 17. Dangerous Weapons.—Especial care must be taken at all times that patients do not become possessed of knives, razors, or dangerous weapons of any kind. Frequent search for such articles must be made in the wards, and when the existence of any is suspected, every possible means must be used to discover them. Anything seen lying about the wards, yards, or grounds that might prove dangerous in the hands of a violent patient, should be carefully and promptly removed. 18. Prohibited Articles.—It is strictly prohibited to patients to use tobacco in any form, while under tho care of this institution. It is a filthy habit, and experi- ence has satisfactorily shown that it is injurious to most persons, and to many excessively so. No patient is to have in his possession any razor, knife, or other article that in his own hands or the hands of others might be used as a dangerous weapon. 4* 34 duties of attendants. Patients are not to receive or forward any letters, par- cels, or packages of any kind, without the knowledge and approbation of the physician. 19. Patients' Clothing. — The clothing of every nctc patient is to be examined at the earliest opportunity after admission, to ascertain whether thero are knives, weapons of any kind, money, tobacco, or other forbidden articles upon his person. If any are found, they are to be promptly given to the steward for safe keeping. The clothing of a patient is not to be taken into a ward until it has been examined, and a list of articles taken by the steward or matron. All new clothing sent to a pa- tient should pass through the same hands, and be regis- tered in the same way, before it is used. No unmarked clothes should go to wash, or be used by a patient. The attendants will carefully see that patients change their clothes regularly, and all reasonable requests in reference to changing clothes are to be gratified. Soiled clothes are never to be allowed to remain in a patient's room, but are at once to be put among those to be sent to the wash-house. The clothing of patients is to be kept neat and clean, and well brushed at all times. If buttons are found to be missing, or holes are seen in a garment, it is to be taken at once to the seamstress to be repaired. If sus- penders or other necessary articles in the wards are found wanting, they are to be asked for till they are furnished. Shoes are to be kept tied—stockings gartered—clothing buttoned or fastened, at all hours, and on all patients. When patients wet their clothing, they are to be changed as often as may be necessary to make them dry and com- fortable, even if every hour. The wet part of their cloth- duties of attendants. 35 ing may be dipped in hot water and dried, but is not to be returned to the ward without undergoing this process. Pains are to be taken to induce patients to be neat in their dress, to wear slippers when within doors, and in wet weather to change their shoes after walking out. In the South Wing, the attendants are expected, under the instructions of the matron and supervisor, to take charge of the patients' clothing, and see that it is carefully preserved and kept in proper order and repair. They will also take charge of any new work or work to be repaired that may be^sent into the ward, occupy them- selves with it, and encourage the patients to give them such aid as will be useful. Attendants can do no private work, except putting their own clothes in order, during the hours of duty, without special leave, nor can they employ the patients to do work for them, if there is any required for the house, without the same permission. 20. Visiting between Wards.—As the duties of each attendant are confined almost exclusively to a single ward, they can have but rare calls in any other unless specially directed by the proper authority to go there. In going to and from the centre building, they will avoid passing through wards not necessarily in their way. Patients, too, are not to visit from ward to ward, with- out permission from one of the physicians—and no patient is to be transferred from one ward to another except by special direction of the physician, unless some high excite- ment may induce the assistant physician to change a pa- tient temporarily. 21. Leave of Absence.—To those who perform their duties faithfully, it is wished to allow as much] relaxa- 30 duties of attendants. tion and as much absence as is consistent with the kind of service required, and the welfare of the patients will permit; but, whenever the absence of attendants is deemed likely to be prejudicial to the patients, they are expected to remain at their posts. Leave of absence is granted only by the physician. If he is absent more than an entire day, the assistant phy- sician is to be applied to, but not otherwise, except under extreme circumstances. The usual time for absence will be from 1£ P. M., or after the patients' and attendants' dinner is entirely finished, till the ordinary hour of return in the evening. On lecture or concert evenings, all who may have been out during the afternoon are expected to return before tea-time. Promptness in returning at the hour up to which leave of absence was given is always to be carefully observed. If unforeseen circumstances positively prevent this for any length of time, word should be sent to the hospital. Without special permission, no one is to leave the pre- mises at any time, or for any purpose, unless in walking with patients, till after the patients begin to retire at 8 P. M. They will be careful always to be inside the enclosure at half past nine, and in their own chambers at a quarter before ten. In returning to their rooms in the evening, care must be taken to avoid disturbing those who have retired, either by the noise of walking or loud conversation. An attendant should not leave his charge during the day, for any purpose, without the consent of one of the officers or of the supervisor. Permission should always be obtained to leave the ward before going out of it to see any visitor, and the absence duties of attendants. 37 should then be short; and visitors are never to be taken through the house or grounds without permission. On the Sabbath, leave of absence is always supposed to be for the purpose of attending Divine worship. If granted for the morning, the attendants are expected to return before dinner; if in the afternoon, (leaving after dinner is fully over, not before l£ P. M.,) to return by the ordinary hour in the evening. In the 6th and 7th wards, having three attendants in common, one will be allowed to go out each Sabbath in rotation, after breakfast is fairly over—provided their presence in the ward is not deemed necessary. When about to leave, the attendants will call at the office and put their keys on the hooks provided for the purpose, and report themselves either to one of the physi- cians, or leave their names and the hour of going out on a slate provided for the purpose, and in like manner re- port themselves on their return. They are never on any occasion to lend their keys to any person, and especially not to a patient, without directions to that effect from the physician. When attendants are absent from their duties for any length of time, on their own private business or for plea- sure, they will have the loss of time deducted on the settlement of their accounts, at the discretion of the phy- sician. Attendants and others employed in the house are not to visit the friends of patients, unless requested to do so by the physician. 22. Notice to Leave and Discharges.—Whenever any one employed wishes to give up his situation, he is only required to give two weeks' notice of his intention. 38 duties of attendants. Whenever the institution wishes to dispense with the services of any one, the same notice will be given, or payment for that period, at the discretion of the physician. Whenever any one is discharged, however, for any violation of rules or improper conduct, no such notice will be given, nor payment made but up to the time of dis- charge. As many very worthy and well-intentioned persons do not possess the natural qualifications to make them valua- ble in the care of the insane, the officers of the institution in all their engagements expressly reserve the right at any time to dispense with the services of any one by giving two weeks' notice, or by paying for that period, and this with or without assigning their reasons therefor. It can never be considered as any mark of disrespect, when an individual is not likely to gain credit or give satisfaction in a station, to give him an opportunity to embrace another pursuit better calculated to advance his own interest. duties of special attendants. 39 DUTIES OF SPECIAL ATTENDANTS. Special attendants are governed by the same rules as other attendants. But, as their duties are commonly lighter than those of the general attendants, they must expect a closer confinement, and a less frequent absence from their charge. They are to be particularly careful in reference to those under their care—are never to leave them alone unless from special permission, and promptly and courteously attend to their rooms, clothing, &c, and to all reasonable requests that may be made to them, if not inconsistent with the general regulations of the institution. They are to exercise a general supervision of other patients in the same ward, take a part in keeping it in good order, and perform such other duties as may be required by the proper officers. 40 DUTIES OF THE WATCHMAN. DUTIES OF WATCHMAN AND WATCHWOMAN. The watchman will commence his rounds at half-past nine o'clock, at which hour he will call at the physician's office for directions for the night. He will keep moving about from ward to ward, during the entire night, and will visit every part of the house (except that occupied by the female patients) at least every hour, frequently pass- ing on the outside of the hospital, and noticing the out- buildings. He will know that all employed about the North Wing are in their rooms at the prescribed hour, and, if he has a doubt on the subject, it is his duty to ascertain the fact by opening the individual's chamber door. He must be kind, gentle, and soothing in his manner to the patients, and take every means in his power to tran- quillize those that are excited, and to allay the fears and apprehensions of the timid. He will see that they are promptly supplied with water when it is asked for, and that all their little reasonable wants are attended to. He will be careful to make as little noise as possible in moving about, and always speak to patients in a low tone of voice. He will notice particularly all unusual sounds in the patients' rooms, and ascertain their cause, or give prompt notice to the proper attendant. When there are sick in the wards, he will pay them DUTIES OF THE WATCHWOMAN. 41 frequent visits—attend to all their wants, and if required administer their medicine. He will report to the physician all irregularities, every instance of neglect, and all violations of rule that may come under his notice in any part of the house, or on the premises—and enter upon the office-book any remarks he may have to make upon the occurrences of the night. He will always report on this book particularly how new patients and those who are sick have passed the night. Should he discover fire in any part of the hospital or out-buildings, if it is not in his power at once to extinguish it, he will immediately give notice to the officers and then to the attendants, but never raise a general alarm. He is to ring the bell at the prescribed hour, start the fires in the kitchen, and perform such other duties as may be assigned him. The attendants being up, and in charge of the wards, at 6 A. M., his duties cease till 1 P. M., after which his time is at the command of the institution till sunset, from which hour he is relieved till 9| P. M. The duties of the watchwoman are confined to the wards occupied by female patients, in which she will spend the night, and be governed by the same rules as the watchman. Both will be careful to perform their responsible trusts with the strictest fidelity—to be constantly vigilant, and never to sleep while on duty. Any suspicion of a want of fidelity in these officers must necessarily disqualify them for their stations. Individuals failing to perform their whole duty, from fear or any other cause, will not be retained in either of these stations. 5 12 duties of the seamstress. DUTIES OF THE SEAMSTRESS. The seamstress of the North Wing, under the direction of the matron, will take charge of all the men's clothing —keep it in good repair—see that it is not unnecessarily mislaid or lost, and that it is properly arranged for use. She will see that all clothing is marked before it is sent to wash, and whenever she finds that articles are missing, she must endeavor to ascertain what has become of them. Clothing that requires repairs will be taken to the clothes-room, each day, by the attendants of the North Wing, and the earliest opportunity must be taken to have it put in order and returned to the wards. All reasonable requests of patients in reference to changes of clothing, &c., are as far as possible to be gratified. In the South Wing, the seamstress will attend to the making and repairing of clothes, as may be directed by the proper officer. She will take especial pains to induce the patients to occupy themselves, and to become interested in their employment. When required, she will assist in the care of the patients. duties of the coachman. 43 DUTIES OF THE COACHMAN. The coachman will take charge of such vehicles and horses as may be directed by the physician, and will see that they are always in good order and ready for use. He will drive out with the patients at such hours and for such time as may be indicated by the physician, and will be careful that no accident occurs. He will report any impropriety that may occur during a ride. He will not stop at any house, nor transact business for any one, while out with the patients, unless he has first received permission or instructions to that effect from the proper officer. 44 duties of THE carpenter. DUTIES OF THE CARPENTER. The carpenter has the immediate care of the carpenter shop, lumber yard, tools, and materials of all kinds, be- longing to that department of the institution, and is con- sidered responsible for their safety and economical use. He will not allow any one to make use of the tools or lumber, without the permission of the physician or stew- ard; and when tools are taken from the shop for any purpose, if not promptly returned, he will report the fact to one of these officers. He will prevent attendants, patients, or others from remaining in the shop, so as to interfere with the work- men, unless they have themselves been sent there to work. No materials are to be taken from the shop or yard by any one without permission from one of the officers. duties of the gardener. 45 DUTIES OF THE GARDENER. The gardener will have the care of the pleasure-grounds, gardens, and green-house, which, under the instructions of the physician, he will keep in good order, and will see that all persons who aid in the performance of the work on these parts of the premises do their duty faithfully and in a proper manner. He will take care of all implements used for these purposes, and see that they are carefully housed and taken charge of. He is to consult the physician in reference to the sale of such seeds or plants as may not be required for the purposes of the institution, and keep a correct list of all sales made by him, with the names of the purchasers and the prices attached, which are to be accounted for to the steward at stated periods. When wishing to be absent, he will apply to the phy- sician or steward for permission. 5* 46 duties of the gate-keeper. DUTIES OF THE GATE-KEEPER. The gate-keeper will remain in or about his lodge, and when he leaves it, except for a very temporary pur- pose, he will see that some one, selected by the physician or steward, supplies his place. He will see that the gates are kept closed, except while some one is passing, and that they are so secured that patients shall not escape thereby; and he shall notice particularly that no improper persons enter the enclosure. He is to be polite and respectful to all persons, visitors and others, who have occasion to pass through the gate, or have business at the hospital. He is to admit no one, unless on business with one of the officers, before 10 o'clock A. M., after sunset, nor after 1 P. M. on Seventh-day (Saturday), nor at any hour on the Sabbath, without permission from the phy- sician. No one, unless visiting one of the officers, will be allowed to remain within the enclosure at night, nor after dark, without express permission from the physician, and all such cases are to be promptly reported. He will lock his gate at a quarter before 10 o'clock, previous to which hour all persons should be inside of the enclosure. All persons returning after that hour are to DUTIES OF TnE GATE-KEEPER. 47 be reported to the physician or steward, according to their position in the house. He will also report each morning to the physician or steward the names of any persons employed who may have been out during the night, and the hour of their return in the morning. He is to request patients and all others to avoid stand- ing in or about the gateway, and he will be careful to report all irregularities or improprieties of any kind that may come under his notice. All persons employed in any way on the premises, and not mentioned specially in these Rules, are expected nevertheless to conform to the general spirit of them in the performance of their various duties. 48 ADMISSION OF VISITORS. ADMISSION OF VISITORS. The following rules for the admission of visitors are appended, that they may be familiar to all employed in the institution:— Visitors are not admitted before 10 o'clock A. M., after sunset, nor on the Sabbath. They are not admitted on the afternoon of Seventh-day (Saturday), unless on special business with the attending managers, or one of the offi- cers of the house. All parts of the hospital not occupied by patients may be shown and explained during the hours for the admis- sion of visitors. No visitor, unless in company with a manager, can be taken into the wards, without permission from the physi- cian to the hospital, or, in his absence, from the assistant physician ; and when visitors are allowed to enter the wards, they will always be accompanied by one of these officers, or by the steward or matron. Visitors are not to pass through the grounds or hospital, without special permission, and they are requested not to stand near the windows, or to converse with the patients from the outside of the building. As this hospital cannot be allowed to become a resort for idle curiosity, it is hoped that the friends of patients, ADMISSION OF VISITORS. 49 and all others, will carefully avoid prolonging their visits unnecessarily. The pleasure railroad, and other contrivances for the amusement of the patients, are not to be used by visitors. It is expressly forbidden to furnish any inmate of this hospital with tobacco in any form; or to deliver to, or receive from, a patient, any letter, parcel, or package, without the knowledge and approbation of the physician. Funds for the use of the patients are to be placed in the hands of the steward, to be used under the direction of the physician. Under ordinary circumstances, carriages are not to enter the enclosure. When for any purpose they have been taken to the centre building, they are never to be left standing there; and drivers are always expected to remain with their vehicles outside of the gateway. When visitors so far forget what is due to the feelings of the afflicted and their friends as to make improper remarks to patients, or to institute indelicate inquiries, all persons will be careful to discountenance such a course of conduct, and abstain from mentioning the names of pa- tients, their peculiarities, or any other circumstances respecting them, a general knowledge of which might be painful to any persons connected with them. None of us would be willing to have our own friends, if laboring under insanity, exhibited to strangers, and we are bound in honor, as far as possible, to protect others from a like exposure. No visitors, unless friends of the officers, are to remain inside of the enclosure after dark without special permis- sion. 50 CONCLUSION. CONCLUSION. This code of rules has been prepared, as has been before remarked, for the purpose of enabling all connected with the Pennsylvania Hospital for the Insane to know the principles upon which it is wished it should be managed, and that they may so conduct themselves as most effectually to advance the best interests of the insti- tution, promote the restoration and happiness of its patients, and, it is believed, contribute to their own com- fort and satisfaction. It is hoped that none will ever engage in any of these situations who do not resolve to do all in their power to perform their prescribed duties to the best of their abili- ties, and who cannot show by their deeds that they have higher motives to actuate them than simply whatever pecuniary compensation it may be in the power of the institution to give them for their services. It is the wish, too, of the friends of this institution, that those engaged in all of its departments should be of such a character as to have only to know what is right and proper to secure its prompt and cheerful performance. Such individuals are sure to receive, and, what is still better, to deserve the respect and good wishes of the benevolent, and the grateful thanks of those who have been under their care. CONCLUSION. 51 To enable all, by frequent reference, to become familiar with the foregoing rules and regulations, each person re- ferred to will be furnished with a copy when entering upon his or her duties. Each attendant's copy is to be sent to the physician's office, with the medicine trays, every Seventh-day (Saturday) evening, and a memorandum of its having been received will be made in it by the assistant physician before it is returned to its owner. It is expected that all engaged in any way in the care of the patients will read these rules carefully, and sufficiently often to make themselves familiar with them, as ignorance of their details cannot be admitted as an excuse for their not being observed. mm &^:iilj&i&P:1 .■.-:t|%;.;tj^B :" -I